Document Detail


Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle.
MedLine Citation:
PMID:  22593128     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: /st> There are few data on the associations between anaemia, allogeneic blood transfusion (ABT), patient blood management, and outcome after arthroplasty in the UK. National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management. Internationally, blood management programmes show encouraging results.
METHODS: /st> We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors. We used these data to modify previously published algorithms for UK practice and audited its introduction prospectively. The retrospective audit group served as a control.
RESULTS: /st> Preoperative haemoglobin (Hb) concentration predicted ABT (odds ratio 0.25 per 1 g dl(-1), P<0.001). It also predicted the length of stay (LOS, effect size -0.7 days per 1 g dl(-1), P=0.004) independently of ABT, including in non-anaemic patients. Patient blood management implementation was associated with lower ABT rates for hip (23-7%, P<0.001) and knee (7-0%, P=0.001) arthroplasty. LOS for total hip replacement and total knee replacement decreased from 6 (5-8) days to 5 (3-7) and 4 (3-6) days, respectively, after algorithm implementation (P<0.001). The all-cause re-admission rate within 90 days decreased from 13.5% (97/717) before to 8.2% (23/281) after algorithm implementation (P=0.02).
CONCLUSIONS: /st> We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice. A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge.
Authors:
A Kotzé; L A Carter; A J Scally
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  108     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  943-52     Citation Subset:  IM    
Affiliation:
Airedale NHS Foundation Trust, Steeton, UK.
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